Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
Acta Neurochir (Wien). 2012 Jul;154(7):1205-12. doi: 10.1007/s00701-012-1394-1. Epub 2012 Jun 1.
Although unilateral laminectomy and bilateral decompression (ULBD) is effective in the treatment of degenerative spondylolisthesis (DSPL), few reports have compared the outcomes of ULBD and instrumented fusion for the treatment of DSPL. We describe here the clinical and radiological outcomes of ULBD and instrumented fusion surgery for the treatment of DSPL after a minimum 3-year follow-up.
We retrospectively analyzed the outcomes of 47 DSPL patients with radicular pain who underwent ULBD or instrumented fusion between January 2005 and December 2007. Clinical outcomes were assessed using the numeric rating scale (NRS) for back and leg pain, the Oswestry Disability Index (ODI), and Short Form-36 Health Survey (SF-36). Radiological outcomes of ULBD were analyzed by determining changes in slippage, disc height translation, and angular difference on simple and dynamic X-rays.
The mean NRS of back pain showed a significantly greater decrease in the fusion than the ULBD group, whereas the mean NRS of leg pain, mean ODI, and mean physical component summary and mental component summary of the SF-36 decreased similarly in the ULBD and fusion groups. Radiologically, the ULBD group showed a 2.1 ± 3.10% change in mean slippage, a 0.15 ± 1.58 mm change in mean translation, a -0.91 ± 4.48° change in mean angular difference, and a -1.83 ± 1.69 mm change in mean disc height. In the ULBD group, three patients had residual pain and three had recurrent pain. In comparison, no patient in the fusion group reported residual pain, whereas five patients experienced recurrent radicular pain caused by adjacent segmental disease.
Our findings suggest that ULBD is the recommendable procedure for the treatment of patients with grade I DSPL who have mainly radicular pain. Although the two groups showed similar clinical outcomes overall, radiological degeneration was not as serious after ULBD treatment. In our analysis, foraminal stenosis is a contraindication for ULBD in the treatment of grade I DSPL.
虽然单侧椎板切除术和双侧减压术（ULBD）在治疗退行性脊椎滑脱症（DSPL）方面是有效的，但很少有报道比较 ULBD 和器械融合治疗 DSPL 的结果。我们在此描述了经过至少 3 年随访的 ULBD 和器械融合治疗 DSPL 的临床和影像学结果。
我们回顾性分析了 2005 年 1 月至 2007 年 12 月间接受 ULBD 或器械融合治疗的 47 例神经根痛 DSPL 患者的结果。临床结果采用数字评分量表（NRS）评估腰痛和腿痛、Oswestry 残疾指数（ODI）和健康调查简表 36 项（SF-36）。通过确定滑脱、椎间盘高度平移和简单及动态 X 线片上的角度差异来分析 ULBD 的影像学结果。
融合组的腰痛 NRS 平均值下降幅度明显大于 ULBD 组，而 ULBD 和融合组的腿痛 NRS 平均值、ODI 平均值以及 SF-36 的生理成分综合评分和心理成分综合评分平均值下降幅度相似。影像学上，ULBD 组的平均滑脱率变化为 2.1±3.10%，平均平移变化为 0.15±1.58mm，平均角度差异变化为-0.91±4.48°，平均椎间盘高度变化为-1.83±1.69mm。ULBD 组有 3 例患者有残留疼痛，3 例患者有复发疼痛。相比之下，融合组无患者有残留疼痛，但有 5 例患者因相邻节段疾病出现复发性神经根痛。
我们的研究结果表明，ULBD 是治疗主要为神经根痛的 I 级 DSPL 患者的推荐方法。尽管两组总体临床结果相似，但 ULBD 治疗后影像学退变并不严重。在我们的分析中，椎间孔狭窄是 ULBD 治疗 I 级 DSPL 的禁忌症。
